August 28, 2013

DynaMed EBM Journal Volume 8, Issue 35

DynaMed Weekly Updates

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: August 28, 2013

Expiration Date: August 28, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote EducationCompany and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each EBM Focus is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1210393Q


Last week 327 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 168 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

For Pressure Ulcers, Air-fluidized Mattresses, Protein Supplements, Radiant Heat Dressings, or Electrical Stimulation May Improve Healing
Reference: (Ann Intern Med 2013 Jul 2;159(1):39), (level 2 [mid-level] evidence)

Pressure ulcers are common in hospitalized patients and may lead to further morbidity, increased costs, and death. A wealth of research has investigated numerous treatment and prevention strategies, but the relative efficacy of different approaches remains unclear. Two recent systematic reviews commissioned by the Agency for Healthcare Research and Quality (AHRQ) assessed the existing evidence for the benefits and harms of multiple strategies.

Pressure ulcer treatments were investigated in a review of a total of 174 randomized trials and observational studies. The quality of the randomized trials was limited, and both clinical and statistical heterogeneity limited the viability of meta-analyses. Follow-up times varied widely, and in many studies, were inadequate to assess complete wound healing. Categories of treatment strategies included support surfaces, nutritional supplements, local wound applications, and other adjunctive therapies.

There was no strong evidence in favor of any intervention, and no comparisons showed significant differences in rates of complete wound healing. However, a number of treatments had moderate evidence for partial healing assessed by reduction in wound size. Air-fluidized mattresses appeared more effective than standard mattresses in 5 studies with 908 patients followed for 4 days to 36 weeks. (The results of these studies were described as "highly consistent," but no meta-analysis was performed), and protein supplements were more effective than no supplementation in 12 studies with 562 patients with 7 days to 10 months follow-up. Radiant heat dressings (noncontact dressings with heating elements to increase capillary blood flow) appeared to reduce wound size compared to other dressings in 4 studies with 160 patients (4-12 weeks follow-up), and electrical stimulation with surface electrodes to apply current directly to the ulcer was more effective than sham stimulation in 9 studies with 397 patients (3-16 weeks follow-up).

There were no significant differences in most other comparisons of treatment strategies. Hydrocolloid dressings were associated with greater reductions in wound size compared to standard care but were also associated with higher risks of skin reactions including inflammation, erythema, and wound deterioration. No comparisons showed significant differences in rates of complete wound healing. There was insufficient evidence to assess risk of harms in most comparisons.

In a companion systematic review of 62 trials evaluating pressure ulcer prevention strategies, advanced static support surfaces were associated with decreased risk of pressure ulcers compared to standard mattresses in 5 trials. Insufficient evidence was found regarding the efficacy of repositioning, nutritional support, and use of creams, dressings, or pads compared with usual care. No meta-analyses were performed for any interventions due to heterogeneity of treatment settings and comorbidities.

For more information, see the Pressure ulcer topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

DynaMed Events

American Academy of Family Physicians (AAFP) Conference, September 24-28, 2013
Senior Deputy Editor Alan Ehrlich, MD, will be attending the American Academy of Family Physicians conference, held at the San Diego Convention Center in San Diego, California. Representatives will be available to discuss peer review, mobile access, and free trial information.

Visit the American Academy of Family Physicians website to learn more about the event and for registration information.

If you would like to meet with a DynaMed representative, please contact us at

Call for Peer Reviews

We are currently seeking reviewers for: